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Cue exposure and response prevention with heavy smokers: a laboratory-based randomised placebo-controlled trial examining the effects of D-cycloserine on cue reactivity and attentional bias

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Abstract

Rationale

Treatments based on exposure/response prevention (Exp/RP) produce only modest benefits in substance dependence disorders. However, a new strategy, which has shown promise in animal models of addiction involves combining Exp/RP with extinction-enhancing pharmacological treatments. A prototype of the latter is D-cycloserine (DCS), a partial agonist at the glycine site of the NMDA receptor.

Methods

In a laboratory-based randomised, double-blind, placebo-controlled trial with non-treatment-seeking heavy smokers (n = 32), we examined the efficacy of Exp/RP combined with DCS (125 mg). Two sessions of Exp/RP were carried out during which cue reactivity was monitored. Effects on attentional bias and/or subjective craving and smoking behaviour were also evaluated after at least 48 h and 2 weeks following session 2 of Exp/RP.

Results

Within- and between-session reductions in cue reactivity were observed in both treatment groups, although the DCS group did not show an enhanced reduction by the end of session 2. However, a subtle effect of DCS on the emotionality subscale of the Tobacco Craving Questionnaire was observed, with a trend towards a sustained reduction in this aspect of craving at 2-week follow-up.

Conclusion

Our findings suggest that two sessions of Exp/RP combined with DCS does not enhance the reduction in episodic cue reactivity in non-treatment seeking smokers. A trend towards a greater sustained reduction in the emotionality scale of the TCQ in the DCS group suggests that further detailed study of the effects of combined Exp/RP-DCS on different aspects of craving is warranted, especially in smokers with a current intention to quit.

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Notes

  1. The modal time between session one and two and between session two and first follow was 48 h. The range was 48–72 h.

  2. Morning and afternoon sessions were balanced across groups (p > 0.1).

  3. Average CO levels were consistent with verbal reports, indicating recent abstinence (SRNT Subcommittee on Biochemical Verification 2002)

  4. In the absence of overt cues, VAS craving correlated with total TCQ-SF scores [r(32) = 0.55; p = 0.001] at baseline (prior to drug treatment and in the absence of overt cues). Similar correlations between the TCQ and VAS ratings have been shown in a previous study under conditions producing high craving (imaginal cue-induced craving; Singleton et al. 2003)

  5. Since there were no interactions between modality and treatment and/or session (F ≤ 1.4; p ≥ 0.2) cue reactivity (VAS and GSR) during each block of Exp/RP was calculated by averaging across the three modalities (imaginal, in vivo and video).

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Acknowledgements

The research was supported by a Medical Research Council (UK) grant (G0802718) awarded to SK, HVM and CJAM. We thank Professors Karin Mogg and Brendan Bradley for kindly supplying the stimulus set used in the attentional probe task, Tom Freeman for comments on the manuscript and the anonymous peer reviewers for their helpful comments and suggestions.

Conflicts of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK

    Sunjeev K. Kamboj, Alyssa Joye, Ravi K. Das, Andrew J. W. Gibson, Celia J. A. Morgan & H. Valerie Curran

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  1. Sunjeev K. Kamboj
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  2. Alyssa Joye
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Correspondence to Sunjeev K. Kamboj.

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Kamboj, S.K., Joye, A., Das, R.K. et al. Cue exposure and response prevention with heavy smokers: a laboratory-based randomised placebo-controlled trial examining the effects of D-cycloserine on cue reactivity and attentional bias. Psychopharmacology 221, 273–284 (2012). https://doi.org/10.1007/s00213-011-2571-2

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